WBR0183

Author	PageAuthor::Mugilan Poongkunran
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Musculoskeletal/Rheumatology
Prompt	[[Prompt::A 60 year old male comes to office with complaints of muscle weakness and cramps while climbing stairs for the past 3 months. He denies any rash, arthralgia and difficulty in swallowing. His symptoms are progressively getting worse. He has no other medical problems. He is a non-smoker and non-alcoholic. His vitals are BP:120/80 mmHg, pulse:72/min, temperature:98F and respirations 14/min. On physical examinations there is proximal weakness in both upper and lower limbs. There is no muscle tenderness. Skin examination is normal. Cardiovascular and respiratory examinations are normal. CPK levels are grossly elevated. Which of the following findings would be seen in this patient?]]
Answer A	AnswerA::High eosinophil count
Answer A Explanation	[[AnswerAExp::Incorrect : High eosinophil is seen in eosinophilic fasciitis, however these patients usually presents with muscle pain, weakness, symmetrical induration of the skin and normal CPK levels.]]
Answer B	AnswerB::High neutrophil count
Answer B Explanation	AnswerBExp::'''Incorrect''' : High neutrophilic count is a non-specific finding and it can be seen in conditions having infectious etiology.
Answer C	AnswerC::High serum ferritin
Answer C Explanation	[[AnswerCExp::Correct : Serum ferritin is an acute phase reactant and is likely to be elevated in any inflammatory disorder.]]
Answer D	AnswerD::High serum albumin
Answer D Explanation	AnswerDExp::'''Incorrect''' : Inflammatory disorder have no relation to the serum albumin levels.
Answer E	AnswerE::Normal ESR
Answer E Explanation	[[AnswerEExp::Incorrect : ESR is likely to be elevated in any inflammatory muscle disorder and not normal.]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Dermatomyositis (DM) and polymyositis (PM) are idiopathic inflammatory myopathies, characterized by the shared features of proximal skeletal muscle weakness and by evidence of muscle inflammation. Dermatomyositis, unlike polymyositis, is associated with a variety of characteristic skin manifestations. Other differential diagnosis for myopahty are hypothyroidism, glucocorticoids, drugs and malignancy. Educational Objective: References: ]]
Approved	Approved::Yes
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